VIDEO: Monitoring for brain metastases key in patients with recurrent EGFR-mutated lung cancer

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So, there are a number of bread-and-butter type of things that we certainly go to. Things like, you know, of course during the clinic visit, taking a good HPI, taking a good history, evaluating patient's symptoms, doing a good physical exam. But of course, you know, I also heavily rely on radiographic imaging, CT scans. So, if, you know, if a patient has undergone kind of definitive therapies like surgical resection, you know, I will likely get, after they completed all their adjuvant therapies, I would likely continue with getting routine CAT scans every three to six months, to kind of monitor for recurrence.

But what I also wanna say is that, certainly brain MRIs very well might play a role as well, especially in the stage four setting, when a patient is doing well on targeted therapy. You know, knowing the propensity that EGFR disease has, as far as going to the central nervous system, even in patients without a known history of brain metastases who otherwise has stage four disease and are on targeted therapies, and maybe doing very well, I'll still get a brain MRI probably at least once a year to evaluate for asymptomatic brain metastases. And then certainly, of course, those patients with a known history of brain metastases, I'll still continue to get routine brain MRIs every three months or so, every three to six months, just to make sure there's no involvement of the CNS. Even in the absence of symptoms.

So, you know, in addition to kind of the role that, you know, radiographic imaging plays, something else that I frequently say, and I think about, and incorporate into my practice is the use of liquid biopsies, or kind of blood-based biopsies that look for circulating tumor DNA. And, you know, maybe not necessarily in the context to evaluate for recurrence or determine the risk for recurrence. However, I do see the potential utility of liquid biopsies in this setting, in this context, probably, you know, very much in the near future.

But what I do currently is, you know, if a patient with stage four EGFR mutant lung cancer has evidence of either disease recurrence or a particular disease progression on a particular therapy, the first thing I really do in the clinic is to send off for a blood-based liquid biopsy, to really evaluate for, you know, potential targetable resistant mutations found in their circulating tumor DNA.

And I'll also add, you know, with these patients with evidence of disease progression, you know, frequently a blood-based liquid biopsy, while may be helpful, may not be enough. You know, very frequently I re-biopsy our patients and get actual tumor tissue. Because a liquid biopsy, while it might reveal a lot, it won't really kind of speak to the possibility of histological change. And so, you know, it's a pretty rare entity. However, it certainly can happen and it's well described that EGFR mutant tumors can potentially transform into small cell lung cancer in very rare case cases, maybe even squamous cell lung cancer. And there may even be other kind of resistance mechanisms that are not picked up on the blood-based biopsy. So frequently I do get a repeat tissue biopsy as well in this context.